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coesright deposit 



HARVARD HEALTH TALKS 

THE CARE OF CHILDREN 
BY JOHN LOVETT MORSE 

PRESERVATIVES AND OTHER 

CHEMICALS IN FOODS: THEIR USE 

AND ABUSE 

BY OTTO FOLIN 

THE CARE OF THE SKIN 
BY CHARLES JAMES WHITE 

THE CARE OF THE SICK ROOM 
BY ELBRIDGE GERRY CUTLER 

THE CARE OF THE TEETH 
BY CHARLES ALBERT BRACKETT 

ADENOIDS AND TONSILS 
BY ALGERNON COOLIDGE 

AN ADEQUATE DIET 
BY PERCY GOLDTHWAIT STILES 

HOW TO AVOID INFECTION 
BY CHARLES VALUE CHAPIN 

PNEUMONIA 
BY FREDERICK TAYLOR LORD 

NEW GROWTHS AND CANCER 
BY SIMEON BURT WOLBACH 



HARVARD HEALTH TALKS 



A " llwm 

f | # m 




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I. Photomicrograph of a section of the tip of a rapidly 
growing onion root, showing the cellular structure. The 
rectangular outlines represent individual cells, the dark 
bodies enclosed are the nuclei. At (A) and (B) are two 
different stages in the division of nuclei preparatory to cell 
division. At (A) individual chromosomes are well shown. 



HARVARD HEALTH TALKS 

NEW GROWTHS AND 
CANCER 

BY 

SIMEON BURT WOLBACH 

SHATTUCK PROFESSOR OF PATHOLOGICAL ANATOMY 
IN HARVARD UNIVERSITY 




CAMBRIDGE 
HARVARD UNIVERSITY PRESS 

LONDON: HUMPHREY MILFORD 

OXFORD UNIVERSITY PRESS 

1922 



N 




A^ 



COPYRIGHT, 1922 
HARVARD UNIVERSITY PRESS 



MAY 31 1922 



©CI.A661892 



HARVARD HEALTH TALKS 

PRESENTING the substance of some 
■*■ of the public lectures delivered at 
the Medical School of Harvard Univer- 
sity, this series aims to provide in easily 
accessible form modern and authorita- 
tive information on medical subjects 
of general importance. The following 
committee, composed of members of 
the Faculty of Medicine, has editorial 
supervision of the volumes published : 

EDWARD HICKLING BRADFORD, 
A.M., M.D., Dean of the Faculty of 
Medicine, and Professor of Orthopedic 
Surgery, Emeritus. 

HAROLD CLARENCE ERNST, A.M., 
M.D., Professor of Bacteriology. 

WALTER BRADFORD CANNON, A.M., 
M.D., George Higginson Professor of 
Physiology. 



NEW GROWTHS AND 
CANCER 



NEW GROWTHS AND CANCER 

I. Cells and Tissues 

THE unit of structure of living mat- 
ter is the cell. Under the micro- 
scope these units or cells are as fully 
evident as are the stones or bricks of a 
building to the naked eye, but in the 
human body there are many more kinds 
of cells than there are materials usually 
employed in building. 

All these different cells which compose 
the complex structures of the body arise 
from a single cell, the fertilized ovum, by 
continuous growth and division and dif- 
ferentiation. In the development of the 
individual, growth and division of cells 
must precede differentiation. Differen- 
tiation results finally in the diverse types 
of cells of the body, each type dedicated 
to the performance of some duty (func- 

9 



HARVARD HEALTH TALKS 

tion) in the body. In general the more 
highly specialized the function the more 
feeble is the power of growth and divi- 
sion that remains with the cell. Some 
ability to grow and divide must remain 
with those cells of the body that are con- 
cerned with the repair of injuries. Thus 
there are cells with two kinds of func- 
tion, one of which is that of growth and 
division for the purpose of repair, and 
another the performance of a highly 
specialized duty such as secretion or 
excretion. 

Groups of cells with similar functions 
are known as tissues. 

In a rough way we may divide the 
cells or tissues of the body into two 
groups, the connective tissues whose 
functions are chiefly mechanical, as 
fibrous tissue, bone, and muscle, and the 
epithelia whose functions are chiefly 
chemical in nature and concerned with 
secretion and excretion, or the produc- 
tion of protective surface material. 
10 




II. Section through human epidermis showing individual 
cells separated by dropsical fluid. The spaces are bridged 
by fibrils because of which the cells have been named 
" prickle " cells. 



NEW GROWTHS AND CANCER 

The connective tissues do not come 
into direct contact with the outer world 
because all surfaces of the body, such as 
the skin, the cavities of glands, and the 
inside of the intestinal and genital tracts 
are covered with epithelia. With but 
few exceptions, the epithelia have one 
surface in contact or communication 
with the outer world, although the route 
is in many instances circuitous. One sur- 
face of epithelium must be in contact 
with connective tissue for the purposes of 
support and nourishment. 

The epithelia are always required to do 
at least two things, preserve their con- 
tinuity of surface and perform some 
chemical function. 

The connective tissues are charac- 
terized chiefly by the peculiarities of 
the substances lying between the cells 
— intercellular substance or matrices 
elaborated by the cells. Intercellular 
substances differ widely according to the 
function of the tissue, rigid and calcified 
11 



HARVARD HEALTH TALKS 

as in bone, pliable and resilient as in 
cartilage, and tough and elastic as in the 
connective tissue of the skin. 

Biologists are beginning to understand 
a few of the processes that take place 
within the cell and at the junction of the 
cell surfaces and surrounding media, but 
the physiology of the intercellular sub- 
stance is still an wholly unexplored field, 
probably of great importance in tumor 
research. 

II. General Statements about 
New Growths 

New growths or tumors of all sorts, 
including cancer, are composed of cells 
which are derived from the cells of the 
body of the individual in whom the 
tumor occurs. 

There are as many different kinds of 
tumors as there are tissues in the body. 
In most other diseases the changes visi- 
ble to the eye are the result of the dis- 
ease, i. e., the reactions of the body to 
12 



NEW GROWTHS AND CANCER 

the cause of the disease. These reactions 
are the evidences of injury and efforts on 
the part of the normal tissues towards 
repair. In cancer (and all tumors) that 
which we see is the disease. Many dis- 
eases, including all infectious diseases, 
run courses dependent upon the pres- 
ence of a definite cause, but the course 
of tumors is dependent upon factors 
inseparable from the tumor cells and 
therefore tumors can be cured only by 
procedures which result in the destruc- 
tion or removal of all of the tumor cells. 

An exact or wholly satisfactory defini- 
tion of tumors or new growths cannot be 
given, but we may summarize the more 
important properties of tumors in the 
following statements : 

A tumor is a new formation or mass of 
cells which arise from preexisting cells in 
the body. While the individual cells of a 
tumor may be exact replicas of normal 
cells, their arrangement is unlike that in 
normal structures, also the cells usually 
is 



HARVARD HEALTH TALKS 

have embryonic characteristics, that is, 
are not fully differentiated. 

Tumors serve no useful purpose and 
grow at the expense of the body as a 
whole. 

The growth of tumors is independent 
of the factors governing the growth of 
normal tissues and is typically without 
limit. 

The independence of growth of tu- 
mors is well illustrated by the fact that 
they often grow with rapidity in individ- 
uals who are losing weight. Huge benign 
tumors of fat cells may occur in persons 
who are otherwise almost without fat 
tissue. 

Of the properties of tumor cells enu- 
merated, the two most important are the 
ungoverned growth rate and the lack of 
differentiation. We say lack of differen- 
tiation because the cells resemble em- 
bryonic cells of the same origin, but if 
tumors arise from preexisting adult cells, 
as we believe they do, this change may 

14 



NEW GROWTHS AND CANCER 

be better expressed as a re-differentia- 
tion or a dedifferentiation. 

There is strong evidence that redif- 
ferentiation of epithelial cells does take 
place in consequence of long continued 
demands upon one of their functions, 
that of repair, involving proliferation, 
and that processes creating this demand 
may be directly responsible for the ori- 
gin of malignant new growths. 

New growths occur as benign forma- 
tions of cells, not intrinsically inimical to 
life, and as malignant formations of 
cells, those with properties inimical to 
life. Benign tumors remain local and are 
usually sharply demarcated from the 
normal tissues in which they arise. Their 
cells, and often their structure, resemble 
those of normal tissues and their chief 
effect is mechanical, in producing de- 
formity or pressure effects. Pressure 
effects from a benign tumor may, of 
course, prove fatal if not relieved when 
the tumor is situated so as to press upon 

15 



HARVARD HEALTH TALKS 

vital structures, as those within the chest 
and skull. 

Examples of benign tumors are ad- 
enomas (gland-like tumors) which arise 
from epithelial tissues, as breast glands; 
and fibromas, chondromas and osteomas, 
arising from fibrous tissue, cartilage and 
bone respectively. A very common 
benign tumor, frequently the cause of 
great distress, is the so-called fibroid of 
the uterus, actually a tumor of smooth 
muscle cells identical in type with those 
forming the wall of the uterus. 

Malignant tumors do not remain local. 
Their cells have the power to invade or 
infiltrate adjacent normal tissues, and 
by their superior power of growth, to 
bring about the destruction of normal 
tissues. Most malignant tumors have 
the property of invading lymphatics 
and blood vessels, so that cells which be- 
come detached are transported to dis- 
tant regions, and there give rise to new 
masses of tumor. This process of exten- 

16 



NEW GROWTHS AND CANCER 

sion is called metastasis. The extensive 
dissections made by surgeons when re- 
moving a relatively small cancer are 
done in anticipation of metastases and 
in these dissections the endeavor is made 
to remove all of the lymphatics and 
lymph nodes directly connected with 
(draining) the locality of the tumor. 

We need not concern ourselves with 
the elaborate nomenclature of tumors. 
Popularly, all malignant tumors are can- 
cers. To the physician malignant tu- 
mors arising from epithelial tissues are 
carcinomas or cancers, while those aris- 
ing from connective tissues are sarcomas. 

Tumors, benign and malignant, are 
supplied by blood vessels, though not 
with nerves. The growth of blood vessels 
which accompanies the growth of tumors 
is purely a secondary response in obe- 
dience to laws governing growth of tissue 
in general. In tumors of epithelial origin 
we have always an accompanying growth 
of connective tissue carrying blood ves- 

17 



HARVARD HEALTH TALKS 

sels, essential for the support and nutri- 
tion of the tumor cells. In malignant 
tumors the cells often grow at a rate 
which is relatively much faster than that 
of the accompanying blood vessels, so 
that the volume of tumor tissue becomes 
too great to be adequately nourished by 
the blood supply. The tumor cells also 
often compress, invade and occlude their 
own blood vessels. These behaviors 
cause the death (necrosis) of portions of 
the tumor, and when the tumor is upon 
the surface of the body the necrotic por- 
tions soften and separate from the main 
mass (slough off). The striking destruc- 
tive action of some tumors (the "eating 
away") is thus accounted for. Foul 
odors associated with tumors are solely 
due to the presence of putrefactive 
(harmless) bacteria which find condi- 
tions favorable for growth in exposed 
necrotic tissues. 

The so-called roots of a cancer are 
simply the irregular extensions of the 

18 



NEW GROWTHS AND CANCER 

growth into normal tissues, they are 
more like branches than roots, should we 
feel obliged to obtain a descriptive term 
from botanical sources. 

III. On the Causes of Cancer 

Cancer is by far the most important 
malignant new growth, and accordingly 
has had the most thought and research 
devoted to its problems. 

I say causes rather than cause of can- 
cer, for the reason that the evidence 
points to more than one initiating cause. 
It is not unreasonable to believe that 
eventually we shall arrive at an under- 
standing of the factor or factors pos- 
sessed in common by the cells of all 
malignant growths, that is the imme- 
diate cause of unlimited ungoverned 
multiplication of cells. 

A consideration of the immediate 
" causes" of tumors would lead us into 
highly technical fields of general biol- 
ogy, biological chemistry and biological 

19 



HARVARD HEALTH TALKS 

physics, all involved in the problems 
of balanced (normal) cell growth in 
the body. Unbalanced, or ungoverned 
growth even to the extreme of unlimited 
growth would seem to be a potentiality 
of many types of cells in the body 
throughout life. In normal cells there 
are factors which control the rate of 
growth and these factors seem to be 
operative chiefly in the cell "membrane" 
and are more or less subject to study. I 
shall give some examples of the way cells 
are stimulated to multiplication. Ova of 
lower animals (the frog for instance) 
which ordinarily require the penetration 
of a spermatozoon to induce multiplica- 
tion, may be stimulated to growth result- 
ing in the formation of embryos by the 
addition of chemicals to the water in 
which they are kept. Such chemicals are 
weak acids and alkaline salts, which ap- 
parently act by affecting the character 
of the cell membrane (Jacques Loeb) 
thereby increasing its permeability. An 
20 



NEW GROWTHS AND CANCER 

increased permeability means breaking 
down barriers between the cell and its 
environment so that potential sources of 
energy within the cell become dynamic. 
Multiplication of cells remotely simulat- 
ing tumor growth in man may be in- 
duced in plants by the injection of acid 
and alkaline substances into plant tis- 
sues, and where such substances can be 
constantly supplied to the cells the 
growth becomes continuous and un- 
limited, as in the case of plant infections 
with a bacterium, Bacterium tumefaciens. 
This bacterium grows within the plant 
cells and as shown by Irwin Smith 
causes continuous proliferation, not by 
any mechanical stimulation, for many 
other bacteria invade plant cells without 
producing a similar result, but by the 
chemical substances elaborated by the 
bacterium. 

A less striking example, but more 
familiar, of plant cell proliferation in 
direct response to chemical stimulus is 
21 



HARVARD HEALTH TALKS 

seen in the production of plant galls by 
the larvae of insects. There are thou- 
sands of species of gall-producing in- 
sects, representing six orders, distributed 
throughout the world. 

In man we have learned that some of 
the conditions governing growth are in- 
fluenced or regulated by the output of 
certain ductless glands. The changes in 
the breasts during pregnancy, in prepa- 
ration for lactation, include extensive 
multiplication of the glandular epithe- 
lium and we know that these changes are 
dependent upon a secretion from the 
ovaries. Disorders of the pituitary gland 
— a ductless gland — influence to a re- 
markable degree the growth of the body, 
and here again we get striking examples 
of over-production of tissues due to the 
presence of, as yet, unidentified chemical 
substances in the blood. Giant growth 
in rats has been experimentally produced 
by repeated injections of pituitary gland 
substance into young individuals. Con- 

22 



NEW GROWTHS AND CANCER 

ditions resulting in under-production on 
the part of the same gland in early life 
retard growth and development to sexual 
maturity. 

Experimentally in animals local 
growths of epithelium can be produced 
as a direct response to the presence of 
injected substances (a dye-stuff dis- 
solved in oil). 

Local over-production of tissues often 
occurs in the repair of injuries on the 
part of such tissues as bone and epithe- 
lium, but after complete healing has 
taken place the excess tissue disappears. 
What happens with repeated injuries and 
in conditions where complete repair is 
not possible is another story, to which I 
shall return. 

I give these cursory illustrations in 
order to show that the problems con- 
nected with the normal and abnormal 
growths of cells are not beyond the scope 
of investigation and to enable me to ven- 
ture the prediction that eventually we 

23 



HARVARD HEALTH TALKS 

shall have in our possession knowledge of 
the fundamental laws relating to cell 
growth and multiplication. Modern 
physical chemistry as applied to bio- 
logical chemistry is rapidly breaking 
ground. 

IV. Tumor Research 

Tumor research is being carried on by 
individuals in all great medical centers, 
and in some universities under special 
endowments, as that of the Crocker 
Fund at Columbia University and the 
Cancer Commission of Harvard. Con- 

Isidering the importance of the subject far 
too few workers are engaged, and the 
capital set aside for financing such re- 
search is absurdly small, in view of the 
magnitude of the problems. If all the 
cancer research institutions of the world 
were fused into one, it is questionable if 
they would yield means and men suffi- 
cient for an adequate organization to 
attack the problems of cancer causation 

24 



NEW GROWTHS AND CANCER 

and therapy along the clearly indicated 
lines of investigation now mapped out. 

I have already indicated the ways in 
which cell growth is being studied. The 
behavior of tumors as a whole in the last 
twenty years has been much studied in 
animals, for it is frequently possible to 
maintain tumors of mice, rats, and fowls 
indefinitely by grafting portions of the 
tumor from individual to individual. 
Such "strains" of tumor exist in many 
laboratories and furnish the means of 
testing out many hypotheses in regard to 
growth, and particularly treatment. 

Growth of cells outside the body has 
become possible in recent years. Normal 
cells as well as tumor cells can be main- 
tained continuously growing in glass con- 
tainers if transferred at intervals to new 
supplies of the proper medium. In the 
case of such "cultures" from normal 
cells we have apparent proof of the un- 
limited growth capacity of cells of simple 
tissues. Obviously such cultures afford 

25 



HARVARD HEALTH TALKS 

opportunities for the investigation of 
factors affecting the growth of mam- 
malian cells not possible in the animal 
body, 

V. Accepted Theories of the 
Origin of Tumors in Man 

A consideration of observed facts in 
man leads us to the conclusion that 
tumors of early life are quite distinct in 
origin from those of late life. In infancy 
and early childhood practically all solid 
tumors are malignant, and mixed tumors, 
that is tumors with two types of cells, are 
common. The tumors appearing in early 
life usually arise in organs which have a 
complicated development and in these 
organs we frequently find, even in adults, 
isolated groups of cells which must have 
remained there from the embryonic 
stage. There is all in all much evidence 
supporting the theory that tumors of 
early life arise from so-called "mis- 
placed" cells or "embryonic rests," cells 

26 



NEW GROWTHS AND CANCER 

which fail to take part in the develop- 
ment of an organ but which remain 
included in the organ. An excellent 
example of an "embryonic rest" is fur- 
nished by the pigmented moles generally 
known to be present from birth. These 
moles consist of groups of pigment- 
forming cells identical with those occur- 
ring normally in some stages of the 
development of the skin. They lie just 
below the epithelial layer of the skin 
(epidermis) and occasionally are the 
seats of origin of a very fatal type of 
tumor. 

Tumors of early life are often asso- 
ciated with gross congenital defects 
which is additional evidence of their 
origin in developmental defects. 

There are tumors of congenital origin, 
seen fairly frequently, which have an 
exceedingly complex structure, contain- 
ing many kinds of tissues, and even abor- 
tive attempts at organ production, so 
that we often find in them bone, car- 

27 



HARVARD HEALTH TALKS 

tilage, teeth, glands and skin with hair. 
These tumors are called teratomas, they 
are usually benign, and I speak of them 
to bring further evidence of the con- 
genital origin of certain tumors, for it is 
evident that they have origin in cells set 
aside very early in the development of 
the fetus. 

On the whole the tumors of early life 
— those of congenital origin — are of 
minor importance compared with those 
of later life. We feel certain of their 
origin in cell rests but have no clue as to 
why some cell rests become tumors and 
others do not. The fact that the study 
of tumors of late life promises more of 
practical value probably accounts for the 
small amount of research given to the 
tumors of early life. 

Of the malignant tumors of late life, 
that is, after forty years, the bulk are 
epithelial. Malignant connective tissue 
tumors (sarcomas) occur, but I can give 
you so little in the way of fact or theory 

28 



NEW GROWTHS AND CANCER 

to account for any of the several types 
that I must dismiss the subject with the 
statement that they are less frequent 
and therefore of lesser moment as com- 
pared with the cancers. 

With benign tumors we are also less 
concerned. They occur frequently and 
may cause great discomfort; for instance 
the fibroid of the uterus (a connective 
tissue type) in women and the adenoma 
of the prostate (epithelial) in men, but 
they are fortunately both amenable to 
treatment by surgery. 

The malignant epithelial tumors (can- 
cers) are by far of greatest importance. 
Twenty-five years ago the idea of cancer 
being associated with or due to other 
pathological processes was scouted. The 
possibility of its being caused by a par- 
asite was eagerly entertained, and hered- 
ity was given a prominent place in all 
discussions. 

Today even the most conservative 
pathologist admits the importance of the 

29 



HARVARD HEALTH TALKS 

effects of long continued injurious or in- 
flammatory processes upon epithelium 
in cancer production. The parasitic 
theory of cancer causation is almost 
wholly abandoned, though the indirect 
effect of certain parasites is held in the 
same regard as that of long continued or 
of ten repeated injuries. The statistician 
has disproved heredity as an important 
factor, and insurance companies attach 
no importance or penalty to a history of 
cancer in the family of an applicant for 
insurance. 

These statements, which meet with 
general scientific approval, may be made 
in regard to cancer in man : — 

Cancer is not infectious, i. e., "not 
catching." 

Cancer is not hereditary. 

Cancer is definitely associated with the 
long persistence of processes, loosely 
called chronic inflammation, in the loca- 
tion in which they arise. Upon the ac- 
ceptance of this last statement rest the 

30 



NEW GROWTHS AND CANCER 

activities of those concerned in cancer 
prophylaxis. 

What is the nature of our evidence 
that cancer may be identified by preced- 
ing conditions? This evidence may be 
grouped under the following headings : — 
Cancer characteristic of certain oc- 
cupations. 
Cancer characteristic of peculiar prac- 
tices of peoples. 
Cancer and its association with chronic 
infectious processes of skin and mu- 
cous membranes. 
The experimental production of can- 
cer by the duplication of the con- 
ditions of some of the above in 
animals. 

VI. Cancer and Recognizable Pre- 
disposing Pathological Conditions 

A. Cancer and Occupation. The classic 
example is that of chimney-sweep's can- 
cer, cancer of the scrotum due to the 
mechanical and chemical action of soot 

31 



HARVARD HEALTH TALKS 

over long periods of time. Gardeners 
who use soot as a fertilizer or fungicide, 
workers in carbon factories, and those 
who handle tar, paraffin, aniline oil and 
other products of the distillation of coal, 
are subject to cancers of the hands and 
face. In all the evolution of the cancer is 
the same, a chronic thickening of the 
skin, i. e., dermatitis, warty growths, 
then ulceration and cancer. 

The last twenty years have furnished 
us with an even more striking example of 
occupational cancer, the cancers of X- 
ray workers. In 1909 Dr. C. A. Porter 
collected thirty-six cases, living and 
dead, and I venture to assert that nearly 
all of the thirty-six are now dead. Most 
of them were in young men, doctors, 
who, as a result of repeated exposure to 
the X-rays incurred in their daily work 
of diagnosis and treatment, developed 
thickening of the skin, warty growths, 
ulcerations and cancer. Heroic fortitude 
and devotion to duty by medical men 

32 



NEW GROWTHS AND CANCER 

have never been better illustrated than 
by the last years of some of these victims, 
for instance, the much honored and 
lamented Walter Dodd of the Massa- 
chusetts General Hospital. 

Wholly analogous to X-ray cancer are 
those arising upon the face and hands of 
persons much exposed to sun and wind, 
farmers and sailors. 

Cancer as an occupational disease is 
an established fact, and as has already 
been demonstrated in practice, easily 
preventable. 

B. Cancers Associated with Peculiar 
Practices. I shall give but three. In 
Kashmir it is the custom for members of 
a certain tribe to wear, for the purpose of 
warmth, a small earthenware stove, en- 
closed in wicker-work, beneath their 
robes. This stove is attached to a belt 
and rests in contact with the skin. As a 
result a chronic inflammation is set up 
and relatively many individuals develop 
cancer of the skin upon this area. Closely 

33 



HARVARD HEALTH TALKS 

related tribes, living at lower altitudes, 
who do not employ this portable stove, 
do not have this disease. Now cancer of 
the skin of the abdomen is extremely 
rare anywhere else in the world, so that 
the evidence of a causal relationship of 
the practice and the disease is very 
strong. 

Another example is that of cancer of 
the cheek in India in women who are 
addicted to chewing betel leaves. The 
preparation of betel leaves, lime and 
other ingredients employed is kept quite 
constantly in one position, between the 
cheek and the teeth, even during sleep. 
The occurrence of cancer on the side 
kept in contact with the betel leaves and 
lime is good evidence of causal relation- 
ship, for cancer of the cheek in women in 
general is very rare. 

I do not know whether to class the 
third example as a peculiar practice or 
not. It was so regarded for a time in all 



34 



NEW GROWTHS AND CANCER 

civilized countries, and when indulged in 
by women is still so regarded in a few 
localities. I refer to smoking ! Cancer of 
the mouth parts and pharynx is incon- 
testably proved to be more common in 
smokers than in non-smokers. Our 
statistics so far apply to men, but eman- 
cipated women will in this respect also 
soon contribute to the world's informa- 
tion. 

C. Cancer and Chronic Infectious Proc- 
esses. In man we have as examples 
syphilis of the mucous membranes, par- 
ticularly of the mouth, and an associated 
relatively high cancer incidence; the fre- 
quent occurrence of cancer upon a form 
of skin tuberculosis known as lupus; and 
cancer of the bladder following chronic 
ulcerations due to the embryos of a 
small worm. The last is a disease very 
common in all parts of Africa. The 
adult worm, a filaria (Bilharzia hema- 
tobia), localizes in veins in the bladder 



35 



HARVARD HEALTH TALKS 

region, and the only route of exit for the 
embryos is through the bladder. 

In rats cancer of the stomach is like- 
wise the indirect result of infection with 
another small worm {Spiroptera neo- 
plastica) which the rat gets from eating 
cockroaches. The embryos of this worm 
are found in the muscles of the cock- 
roach. This cancer of rats has been re- 
produced experimentally by introducing 
the Spiroptera embryos into the rat's 
food. 

D. Experimental Production of Cancer 
in Animals. Experimentally cancer has 
been reproduced in animals by X-ray 
exposures (the cases in man may be re- 
garded as unintentional and uncon- 
ditioned experiments), by inoculation 
with the cockroach rat worm, and by 
long continued applications to the skin of 
substances obtained from coal tar. 



36 



NEW GROWTHS AND CANCER 

VII. Analysis of the Conditions 
Antecedent to Cancer in its Rela- 
tion to Chronic Pathological Proc- 
esses of Diverse Types 

Is there a plausible explanation to ac- 
count for cancer formation following long 
continued inflammatory processes? 

In analyzing the conditions we must 
consider several facts: (1) that the new 
growths are always of epithelial origin, 
i. e., cancer; (2) that epithelium is de- 
pendent upon the supporting connective 
tissue with its blood and lymphatic sup- 
ply for nourishment; (3) that one of the 
functions of epithelium is to cover sur- 
faces, and that, therefore, it has great 
proliferative powers; and, finally (4) 
that all the known chronic processes 
leading to cancer formation are attended 
by repeated destructive changes in the 
connective tissue supporting the epithe- 
lium, thereby leading to recurring breaks 
in continuity of the epithelium neces- 



37 



HARVARD HEALTH TALKS 

sitating repair by proliferation. Further- 
more, as a result of the persisting in- 
flammatory processes, the supporting 
connective tissue remains subject to 
constant or recurring changes resulting 
in conditions presumably less adequate 
than the normal for the nutrition of the 
epithelium. There is much evidence, 
but of too technical a nature to be dis- 
cussed here, which indicates that the 
origin of some internal cancers takes 
place upon seats of long continued in- 
flammatory processes. 

Now the time element is important in 
cancer production. In man, years, in X- 
ray cancer a minimum of six years, are 
required. In animals it requires the re- 
peated application of coal tar products 
for a year or more in order to produce 
new growths. 

These observations lead to the con- 
clusions that the acquisition of the power 
of unrestrained growth is a slow process, 
that it is one restricted to the locality 

38 



NEW GROWTHS AND CANCER 

subjected to the injuries, that it is a 
property of individual cells and not de- 
pendent on factors affecting the body as 
a whole, and that it is a result of the re- 
peated calls for the performance of the 
function of multiplication at the expense 
of more highly specialized functions. 

The acceptance by the medical world 
that long continued inflammatory proc- 
esses of various and diverse causation 
may result in cancer production is a fact 
of greatest importance, as it points to 
certain rational measures of prevention, 
and justifies surgical procedures now em- 
ployed. If the reasoning I have just pre- 
sented is a true interpretation of what 
occurs, it accounts for the beliefs firmly 
held by most of us that cancer is in its 
beginning a local disease, and not trans- 
missible by heredity. 

VIII. The Treatment of Cancer 

To find a means of preventing the 
growth of tumor cells or of destroying 

39 



HARVARD HEALTH TALKS 

them completely without inflicting im- 
portant damage to the body as a whole is 
the goal of all cancer research. All biolog- 
ical research directed towards the under- 
standing of the behavior of living matter 
is cancer research, and I am inclined to 
believe that the researches of persons 
who know little or nothing about cancer 
are contributing the most fundamental 
information, as they have done in the 
past. The known agents which can be 
employed are radiant energy, from 
radium and the X-rays, and possibly 
chemical compounds. 

Theoretically success is dependent 
upon the possible existence of differences 
in manner of living (metabolism) be- 
tween normal cells and cancer cells, and 
the further possibility that such dif- 
ferences may enhance the susceptibility 
of cancer cells to the agents at our com- 
mand. Have we evidence that such 
differences exist? I have already men- 
tioned that the cells of tumors are less 

40 



NEW GROWTHS AND CANCER 

differentiated than the normal type, that 
tumors have no nerve supply, and that 
they have an atypical blood supply and 
arrangement of cells. 

Experiments upon animals and prac- 
tice upon cancer cases in man have 
shown a decidedly greater susceptibility 
of tumor cells to X-rays and radium as 
compared with most normal tissues. 
Superficial tumors have been completely 
destroyed by both agents. Deep seated 
tumors present difficulties because the 
radiant energy of the X-ray tube and 
radium is deleterious to all tissues and 
the estimated required dosage cannot 
always be applied with safety and per- 
haps not achieved with the present X- 
ray apparatus or supply of radium. Each 
year sees some advance in the progress 
made with these physical agents and the 
possibilities are by no means exhausted 
in regard to volume of rays and kind of 
rays, for the rays from X-ray tubes and 
radium vary in wave length just as do 

41 



HARVARD HEALTH TALKS 

the longer rays we call light. We may 
look with interest to the future achieve- 
ments from the new laboratory of the 
Harvard Cancer Commission, with its 
new and powerful apparatus yet to be 
tried upon patients. 

The investigation of chemical agents 
is necessarily still restricted to animals. 
Faint clues seem to be at hand as there 
is evidence that in the transplantable 
tumors of mice the tumor cells have a 
greater affinity for certain organic salts 
of the heavy metals than have normal 
cells, the most striking effect obtained 
thus far being that with a compound of 
the metal tellurium and the dye-stuff 
eosine. The growth of sarcomas in rats 
has been remarkably retarded by the use 
of a chemical (phloridzin), the admin- 
istration of which causes a great loss of 
carbohydrates from the body by way 
of the urine. Lime in excess in the food of 
rats also is reported to retard the rate of 
growth of sarcomas. These observations 

42 



NEW GROWTHS AND CANCER 

as yet are of no practical importance 
whatever, but they apparently demon- 
strate that there are accessible differ- 
ences between tumor cells and normal 
cells and that the subject is one open to 
experimentation. 

The practical procedures in tumor 
treatment are two: surgery and X-rays 
or radium. Surgery aims at complete 
removal of the new growth. Therefore 
success with surgery is dependent upon 
whether or not complete removal is 
physically possible or compatible with 
life of the individual. As cancer is a local 
disease, there is always a stage when 
complete removal and cure is possible. 
Successful surgical treatment then is a 
matter of early removal. 

X-rays and radium require very spe- 
cial knowledge for their application, and 
are positively dangerous in the hands of 
the inexperienced. Like many delete- 
rious agents, a weak dosage may stim- 
ulate where a strong dosage destroys. 

43 



HARVARD HEALTH TALKS 

The medical profession as a whole advo- 
cates surgery in all cases where a com- 
plete removal of a tumor is possible, 
except in cases of benign tumors and the 
less dangerous cancers of the surfaces of 
the body. But these agents have other 
very important uses in cancer therapy, 
first as adjuncts to surgical treatment, 
and second as palliative measures, and it 
is often possible by their means to cause 
superficial healing of exposed tumors, 
thereby removing the source of foul odors 
and irritating discharges, thus adding 
greatly to the comfort of the patient. 

IX. Prophylaxis 

Last year (1921) the American Society 
for the Control of Cancer inaugurated a 
Cancer Week which was held a few 
months ago in every city of size through- 
out the country. Doctors and Public 
Health officials were called upon to give 
lectures and demonstrations for the pur- 
pose of informing the public (medical as 

44 



NEW GROWTHS AND CANCER 

well as lay) about cancer, in an effort to 
reduce the death rate. As cancer cannot 
be transmitted from person to person 
(not "catching") the whole purpose of 
the campaign was to educate individuals 
and, sad to say, doctors as well. The 
campaign was justified by two public 
conditions, the ignorance and indiffer- 
ence of individuals in regard to the early 
evidence of cancer, and the too frequent 
lack of discrimination shown by persons 
in selecting the kind or cult of medicine 
for their treatment. 

Cancer prevention is wholly a matter 
pertaining to the individual. 

The avoidance of exposure to the 
known initiating causes, the paying of 
attention to signs possibly indicative of 
early cancer, arid the consultation of a 
reputable physician with the purpose of 
following his advice, sum up what is 
practical in the prophylaxis of cancer. 

What signs should lead us to suspect 
the presence of a cancer or conditions 

45 



HARVARD HEALTH TALKS 

liable to be followed by one? The signs 
of cancer in places that we can ourselves 
inspect are usually very evident. An 
increase in size of a mole, a lump appear- 
ing in the breast, warty growths of the 
skin followed by shallow scabbed ulcera- 
tion, fissures or tiny ulcers of the lips, 
cheeks or tongue, that do not heal, are all 
examples of possible early cancer that 
are commonly neglected. It is estimated 
that there are over eight thousand 
deaths from cancer of the breast yearly 
in the United States, most of which could 
have been cured if taken in hand early 
enough. 

In regard to the internal organs, any 
new and persistent symptoms in a per- 
son past forty years of age should be 
looked into. Sudden constipation in a 
previously regular person, or the onset 
of a dysentery which remains persistent, 
or bleeding from the rectum, may be the 
first indication of a cancer of the lower 
bowel. In women persistent flowing 

46 



NEW GROWTHS AND CANCER 

between periods and after the meno- 
pause are suggestive of early cancer of 
the uteres. 

Pain is a late symptom of cancer, its 
presence indicates sufficient extension of 
the new growth to cause pressure upon 
nerves and hence cancers causing much 
pain are usually less favorable cases for 
treatment. 

X. On Cancer Statistics 

The death rate from cancer for recent 
years in countries where causes of death 
are registered varies roughly from 75 to 
90 per 100,000 persons. This means that 
cancer as a cause of death ranks with 
pneumonia, tuberculosis, and kidney 
diseases, and that about one death in 
ten is caused by cancer. In the United 
States the estimated number of deaths 
from cancer for the year 1918 was 90,000. 
The number of recorded deaths from 
cancer throughout the civilized world is 
increasing each year and the annual in- 

47 



HARVARD HEALTH TALKS 

crease in the death rate (i. e., number of 
deaths per 100,000 persons) is estimated 
at about 2.5 per cent. If the annual in- 
crease of the recorded death rate from 
cancer is actually the result of a cor- 
responding increase in the rate of inci- 
dence of cancer, we may be said to be 
facing a situation of very grave portent. 
Some statisticians and apparently the 
Committee on Publications of the Amer- 
ican Society for the Control of Cancer 
do believe that this situation exists. The 
determination of the incidence of cancer 
or of the number of deaths due to cancer 
each year is a matter attended with 
many difficulties and plausible explana- 
tions have been advanced to account for 
the apparent rapid increase in the death 
rate. Cancer statistics is mathematics 
applied to a biological problem. While 
we cannot impugn the mathematics, we 
are in duty bound to question the 
premises, in this case the death returns 
in the registration states. Do they tell 

48 



NEW GROWTHS AND CANCER 

the whole story, taking into considera- 
tion all the possible causes of error, such 
as improvements in diagnosis, the in- 
crease in number of well trained phy- 
sicians to make diagnoses, and the 
lengthening of human life so that now 
more persons reach the cancer age? 

I quote the following concluding para- 
graph of a paper by Professor Willcox of 
Princeton: "On the Alleged Increase of 
Cancer. 55 "The cumulative evidence 
that improvements in diagnosis and 
changes in age composition explain 
away more than half and perhaps all of 
the apparent increase in cancer mortality 
rebuts the presumption raised by the 
figures and makes it probable, although 
far from certain, that cancer mortality is 
not increasing." Professor Willcox's 
analysis of the problem and the data he 
presents carry conviction to those of us 
who have held fixed, if hazy ideas, that 
there was something wrong about the 
story as told by statistics alone. 

49 



HARVARD HEALTH TALKS 

I think we may feel fairly secure in 
continuing our general habits of living 
and without the fear that we are drifting 
towards an era of cancer. Cancer pro- 
phylaxis remains a problem concerning 
individuals, and education our sole 
means of effecting results. 

XI. A Final Word 

The dread of cancer and the reputed 
futility of medical treatment have al- 
ways made it easy for the unscrupulous 
and ignorant pretender in medicine, 
whether or not the holder of a medical 
degree, to appeal successfully to cancer 
patients. The possessors of secret rem- 
edies for cancer, usually a salve or paste 
which removes the cancer — * ' roots ' ' 
and all! — in order to avoid the laws 
governing the practice of medicine, now- 
a-days attempt to treat patients under 
the direction of a registered physician. 
All such cancer pastes contain caustic 
substances which kill tissues, normal 

50 



NEW GROWTHS AND CANCER 

as well as cancer, though the claim is 
usually made that a wonderful herb in- 
troduced into the mixture is the active 
agent. There is proof that cancer pastes 
were used before the pyramids were 
built, so we may confidently say that 
their efficiency has had a fair trial. Rem- 
edies for internal administration have 
disappeared, except under the cover of 
secrecy. The Propaganda for Reform of 
the American Medical Association and 
the Federal Bureau of Chemistry have 
already eliminated the possibility of 
advertising anything as flagrantly fraud- 
ulent as cancer cures by mouth. 

Wonderful contributions to therapeu- 
tics have been and still are being made 
through the observations of laymen, but 
they represent a minute portion of all 
that has been offered. Today medicine 
is resolutely discarding many things 
once used for treatment of disease, but 
now shown to be valueless, and the prac- 
tice of medicine begins to achieve the 

51 



HARVARD HEALTH TALKS 

status of applied science in biology. In 
science there are no secrets and no cults. 
Science is built upon demonstrable facts 
learned through observation repeated 
many times, and experimentation rigidly 
controlled. Facts alone are valid prem- 
ises for theories and hypotheses, and for 
the imagination of genius which leads to 
further progress . The reliable knowledge 
of the world is common property in that 
it is freely accessible to everyone. The 
claims of cults, medical or religious, and 
of individuals, to exclusive knowledge of 
disease and its treatment, should be re- 
garded as unscientific, unreliable and 
possibly fraudulent in its inception if not 
in intention. 

The more rapidly the public learns to 
be discriminating in its choice of phy- 
sicians, the more rapidly will the stand- 
ards in the practice of medicine become 
elevated. Appreciation on the part of 
the public of the problems of medicine 
to the extent that we appreciate me- 

52 



NEW GROWTHS AND CANCER 

chanical problems would accomplish 
much. The possessor of a fine watch 
usually makes inquiries before he en- 
trusts it to a person for cleaning or re- 
pairs; how many of us do the same in 
selecting a physician? We must remem- 
ber that doctors are first of all men, with 
the moral failings and intellectual de- 
ficiencies common to mankind, equipped 
for the practice of their profession with a 
technical training and not with a myste- 
rious something. Never select a doctor 
whom you would not accept as a friend 
and thus gauge his character, but de- 
mand as well a fair degree of professional 
competence. No one person can be ex- 
pert in all branches of medicine, but we 
can rely upon any doctor morally quali- 
fied to practise his profession, and of 
average competence, to bring to the 
assistance of his patients the available 
resources of medical science whereso- 
ever and in whomsoever to be found. 



53 



PBINTED AT 

THE HARVARD UNIVERSITY PRESS 

CAMBRIDGE, MASS., U. S. A. 



